Inter-hospital variation in the utilization of diagnostics and their proportionality in the management of adult community-acquired pneumonia (2024)

Vestjens, S. M. T., Wittermans, E., Spoorenberg, S. M. C., Grutters, J. C., van Ruitenbeek, C. A., Voorn, G. P., Bos, W. J. W. (2018). Inter-hospital variation in the utilization of diagnostics and their proportionality in the management of adult community-acquired pneumonia. Pneumonia, 10(15), Article 15. https://doi.org/10.1186/s41479-018-0059-0

Vestjens, Stefan M T ; Wittermans, Esther ; Spoorenberg, Simone M C et al. / Inter-hospital variation in the utilization of diagnostics and their proportionality in the management of adult community-acquired pneumonia. In: Pneumonia. 2018 ; Vol. 10, No. 15.

@article{3cf48e650c9c42249df35d13ee970a19,

title = "Inter-hospital variation in the utilization of diagnostics and their proportionality in the management of adult community-acquired pneumonia",

abstract = "Background: Utilization of diagnostics and biomarkers are the second largest cost drivers in the management of patients hospitalized with community-acquired pneumonia (CAP). The present study aimed to systematically assess the inter-hospital variation in these cost drivers in relation to antibiotic use in CAP.Methods: Detailed resource utilization data from 300 patients who participated in a multicenter placebo-controlled trial investigating dexamethasone as adjunctive treatment for community-acquired pneumonia was grouped into 3 categories: clinical chemistry testing, radiological exams, and microbiological testing. Based on the identified top 5 items per category, average costs were calculated per category and per hospital. Antibiotic de-escalation at day 3 and secondary ICU admission were assessed as outcomes for proportionality of diagnostics use.Results: The mean costs for diagnostics varied between hospitals from 350 (SD 31) to 841 (SD 37) euro per patient (p < 0.001). This difference was primarily explained by variation in costs for microbiological testing (mean 195 vs. 726 euro per patient, p < 0.001). There was no difference in number of secondary ICU admissions but there was an inverse association between the costs of microbiological testing and level of antibiotic de-escalation. De-escalation occurred most frequently in the hospital with the lowest cost for microbiological testing (48% vs. 30%; p = 0.018). The latter hospital had an automated physician alert system in place to consider a timely iv-to-oral switch of antibiotics.Conclusions: Large inter-hospital variation exists in resource utilization, mainly in microbiological diagnostics in the management of adult patients with community-acquired pneumonia. A counterintuitive inverse association between the magnitude of these costs and the amount of antibiotic de-escalation was found. Future studies about the optimal cost-effective set of microbiological testing for antimicrobial stewardship in pneumonia patients should acknowledge the interaction between testing, way of communication of results and triggered physician alert systems.Trial registration: ClinicalTrials.gov NCT01743755.",

keywords = "Community-acquired pneumonia, Costs and cost analysis, Microbiological testing, Antimicrobial stewardship, Choosing wisely",

author = "Vestjens, {Stefan M T} and Esther Wittermans and Spoorenberg, {Simone M C} and Grutters, {Jan C} and {van Ruitenbeek}, {Charlotte A} and Voorn, {G Paul} and Bos, {Willem Jan W} and {van de Garde}, {Ewoudt M W}",

year = "2018",

month = dec,

day = "25",

doi = "10.1186/s41479-018-0059-0",

language = "English",

volume = "10",

journal = "Pneumonia",

issn = "2200-6133",

publisher = "BioMed Central",

number = "15",

}

Vestjens, SMT, Wittermans, E, Spoorenberg, SMC, Grutters, JC, van Ruitenbeek, CA, Voorn, GP, Bos, WJW 2018, 'Inter-hospital variation in the utilization of diagnostics and their proportionality in the management of adult community-acquired pneumonia', Pneumonia, vol. 10, no. 15, 15. https://doi.org/10.1186/s41479-018-0059-0

Inter-hospital variation in the utilization of diagnostics and their proportionality in the management of adult community-acquired pneumonia. / Vestjens, Stefan M T; Wittermans, Esther; Spoorenberg, Simone M C et al.
In: Pneumonia, Vol. 10, No. 15, 15, 25.12.2018.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Inter-hospital variation in the utilization of diagnostics and their proportionality in the management of adult community-acquired pneumonia

AU - Vestjens, Stefan M T

AU - Wittermans, Esther

AU - Spoorenberg, Simone M C

AU - Grutters, Jan C

AU - van Ruitenbeek, Charlotte A

AU - Voorn, G Paul

AU - Bos, Willem Jan W

AU - van de Garde, Ewoudt M W

PY - 2018/12/25

Y1 - 2018/12/25

N2 - Background: Utilization of diagnostics and biomarkers are the second largest cost drivers in the management of patients hospitalized with community-acquired pneumonia (CAP). The present study aimed to systematically assess the inter-hospital variation in these cost drivers in relation to antibiotic use in CAP.Methods: Detailed resource utilization data from 300 patients who participated in a multicenter placebo-controlled trial investigating dexamethasone as adjunctive treatment for community-acquired pneumonia was grouped into 3 categories: clinical chemistry testing, radiological exams, and microbiological testing. Based on the identified top 5 items per category, average costs were calculated per category and per hospital. Antibiotic de-escalation at day 3 and secondary ICU admission were assessed as outcomes for proportionality of diagnostics use.Results: The mean costs for diagnostics varied between hospitals from 350 (SD 31) to 841 (SD 37) euro per patient (p < 0.001). This difference was primarily explained by variation in costs for microbiological testing (mean 195 vs. 726 euro per patient, p < 0.001). There was no difference in number of secondary ICU admissions but there was an inverse association between the costs of microbiological testing and level of antibiotic de-escalation. De-escalation occurred most frequently in the hospital with the lowest cost for microbiological testing (48% vs. 30%; p = 0.018). The latter hospital had an automated physician alert system in place to consider a timely iv-to-oral switch of antibiotics.Conclusions: Large inter-hospital variation exists in resource utilization, mainly in microbiological diagnostics in the management of adult patients with community-acquired pneumonia. A counterintuitive inverse association between the magnitude of these costs and the amount of antibiotic de-escalation was found. Future studies about the optimal cost-effective set of microbiological testing for antimicrobial stewardship in pneumonia patients should acknowledge the interaction between testing, way of communication of results and triggered physician alert systems.Trial registration: ClinicalTrials.gov NCT01743755.

AB - Background: Utilization of diagnostics and biomarkers are the second largest cost drivers in the management of patients hospitalized with community-acquired pneumonia (CAP). The present study aimed to systematically assess the inter-hospital variation in these cost drivers in relation to antibiotic use in CAP.Methods: Detailed resource utilization data from 300 patients who participated in a multicenter placebo-controlled trial investigating dexamethasone as adjunctive treatment for community-acquired pneumonia was grouped into 3 categories: clinical chemistry testing, radiological exams, and microbiological testing. Based on the identified top 5 items per category, average costs were calculated per category and per hospital. Antibiotic de-escalation at day 3 and secondary ICU admission were assessed as outcomes for proportionality of diagnostics use.Results: The mean costs for diagnostics varied between hospitals from 350 (SD 31) to 841 (SD 37) euro per patient (p < 0.001). This difference was primarily explained by variation in costs for microbiological testing (mean 195 vs. 726 euro per patient, p < 0.001). There was no difference in number of secondary ICU admissions but there was an inverse association between the costs of microbiological testing and level of antibiotic de-escalation. De-escalation occurred most frequently in the hospital with the lowest cost for microbiological testing (48% vs. 30%; p = 0.018). The latter hospital had an automated physician alert system in place to consider a timely iv-to-oral switch of antibiotics.Conclusions: Large inter-hospital variation exists in resource utilization, mainly in microbiological diagnostics in the management of adult patients with community-acquired pneumonia. A counterintuitive inverse association between the magnitude of these costs and the amount of antibiotic de-escalation was found. Future studies about the optimal cost-effective set of microbiological testing for antimicrobial stewardship in pneumonia patients should acknowledge the interaction between testing, way of communication of results and triggered physician alert systems.Trial registration: ClinicalTrials.gov NCT01743755.

KW - Community-acquired pneumonia

KW - Costs and cost analysis

KW - Microbiological testing

KW - Antimicrobial stewardship

KW - Choosing wisely

U2 - 10.1186/s41479-018-0059-0

DO - 10.1186/s41479-018-0059-0

M3 - Article

C2 - 30603378

SN - 2200-6133

VL - 10

JO - Pneumonia

JF - Pneumonia

IS - 15

M1 - 15

ER -

Vestjens SMT, Wittermans E, Spoorenberg SMC, Grutters JC, van Ruitenbeek CA, Voorn GP et al. Inter-hospital variation in the utilization of diagnostics and their proportionality in the management of adult community-acquired pneumonia. Pneumonia. 2018 Dec 25;10(15):15. doi: 10.1186/s41479-018-0059-0